Peer to Peer Support
Training Manual
This document was produced and distributed through an IDEA
Mandated Activities Project for START (STatewide Autism
Resources and Training) awarded by the Michigan Department of
Education (MDE).
Peer to Peer Support Manual
This manual was designed to assist school personnel in developing a peer to
peer support program.
This manual is organized in three main sections.
I. A description of the peer to peer support program,
II. Forms needed to establish a program and the scheduling process,
III. Permission slips required for students to participate in the program.
The description of the program may vary according to the age level of the
students who may participate in the program. The description should include:
What is a Peer to Peer Support, Who Can Be a Peer to Peer Support Student,
The Responsibilities of a Peer to Peer Support Student, and the benefits of being
a Peer to Peer Support Student.
There are two forms that provide a description of the peer to peer support
program: Elementary and Secondary
The scheduling process is critical to the development of the peer to peer support
program. Each peer to peer support student must be scheduled into the class
and with the student they are supporting
Lunch and Recess Schedule
Semester Schedule
Program Schedule
Establishing a peer to peer support program requires forms that promote
participation and accountability in the program. Forms are used as a system for
recording the peer to peer supports students’ activities within the program. The
forms are also used as documentation for students with ASD. There are
multiple forms in this section. They are listed below:
Homework Sheet
Case Conference Information Sheet
Case Conference Action Plan
Peer to Peer Support Lunch Information Sheet
Secondary Rules
Secondary Checklist 1 Hour
Secondary Checklist 2nd- 6th Hour
Secondary Checklist 7th Hour
Grid for Peer to Peer Behavior
Training Invitation
Peer to Peer Support Playground Checklist
It is critical that permission is obtained from both the parents or guardians and
the general education teacher classes in which they attend. There are several
permission slips for different activities. The permission slips are listed below.
Elementary Peer to Peer Permission
Secondary Peer to Peer Permission
Case Conference Permission Slip – Parents
Case Conference Permission Slip – General Education Teacher
Lunch/Recess Permission
This manual is not all inclusive. Many of these forms may not be necessary for
the development of the program, and depending on your district or building you
may need to add additional forms. This manual was intended to give you a
starting point in the development of your peer to peer support program.
Good Luck with the development of your program. So many students will have
the opportunities to grow in ways that you can’t even imagine with a chance to be
a part of a peer to peer support program.
The START Staff
Table of Contents
Creating a Peer to Peer Support System
Description of a Peer to Peer Support Program
Peer to Peer Support Program Levels
Description – Peer to Peer Support – Elementary
Description – Peer to Peer Support – Secondary
Forms to Establish a Program & the Scheduling Process
The Scheduling and Accountability Process
Lunch and Recess Elementary
Peer to Peer Support – Playground Checklist
Master Schedule
Organizational System for the Peer to Peer Support Program
Peer to Peer Support Program – 1st Hour Checklist
Peer to Peer Support Program – 2nd-6th Hour Checklist
Peer to Peer Support Program – 7th Hour Checklist
Rules of the Peer to Peer Support Program
Peer to Peer Support Program Behavioral System
Invitation to Attend Peer to Peer Support Training
Information about Autism Spectrum Disorder
Accountability and Promoting Student Involvement
Peer to Peer Support Master Schedule
Student Daily Schedule Sheet
Homework Sheet
Student Information Sheet
The Lunch Peer to Peer Support Sheet
Permission Slips to Participate in the Program
Permission Slip – Peer to Peer Support Program
Permission Slip – Secondary
Permission Slip – Elementary
Permission Slip – Lunch and Recess
Case Conferences
Permission Slip – Teacher – Case Conference
Permission Slip – Parents – Case Conference
Case Conference Information Sheet
Case Conference Action Plan
Maintenance
Peer to Peer Support Student of the Week
Description of a Peer
to Peer Support
Program
 Peer to Peer Support
Program Levels
What is a Peer to Peer Support Student?
A peer to peer support student is a volunteer who supports a
student with Autism Spectrum Disorder under adult supervision
Who can become a Peer to Peer Support Student?
Peer to peer support students are selected on a voluntary basis from
the 4th and 5th Grade classrooms at ____________ School. Peer to
Peer Support Students must have parent and teacher permission to
participate in the program.
What are the Peer to Peer Support Student Responsibility?
A Peer to Peer Support Student participates in the program one day
each week for ½ hour. He/she follows the same schedule for one
semester. Peer to peer support students are there to participate in
the activities scheduled and be models for the students with ASD.
The peer to peer supports students will be under the direction of
(social worker, caseload teacher, etc)
Benefits of the Peer to Peer Support Program.
The peer to peer support program provides many opportunities for
general education students, as well as the students with ASD.
Students learn to relate to people with different needs and develop
and increased understanding of individual differences. Student
responsibility is also encouraged.
What is a Peer to Peer Support Student?
A peer to peer support student schedules the peer to peer support
class just as they would for any other elective class. The student’s
commitment requires permission from parents or guardians. The
student will support a student with Autism Spectrum Disorder
(ASD) in both academic and social settings with adult supervision.
Who can become a Peer to Peer Support Student?
Peer to peer support students apply through the scheduling process.
The students are selected through availability of placement in the
program. All students have the opportunity to be a peer to peer
support…although because of scheduling it may be more difficult
for 6th and 9th graders.
What are the Peer to Peer Support Student Responsibility?
Peer to peer support students participate in the program 5 days a
week during their scheduled class period. He/she follows the same
schedule for one semester. While working in the program, the
students provide peer support while participating in the activities
scheduled. The primary responsibility of a peer to peer support
student is to be a model for the student with ASD.
Benefits of the Peer to Peer Support Program.
The peer to peer support program provides many opportunities for
general education students, as well as the students with ASD.
Students learn to relate to people with different needs and develop
an increased understanding of individual differences. Encouraging
student responsibility is also an added benefit of the program.
Forms to Establish a
Program & the
Scheduling Process
 The Scheduling and
Accountability Process
Lunch and Recess
(Peer to Peer Supports) (Elementary)
(Give to the General Education Teachers)
These students will be Lunch and Recess (Peer to Peer
Supports) until the end of the (semester/school year)
Student with ASD name: ______________________
Day of the week
(Peer to peer support name)
Lunch: _________________________
Monday
Recess: ________________________
Alternate: _______________________
Lunch: _________________________
Tuesday
Recess: ________________________
Alternate: _______________________
Lunch: _________________________
Wednesday
Recess: ________________________
Alternate: _______________________
Lunch: _________________________
Thursday
Recess: ________________________
Alternate: _______________________
Lunch: _________________________
Friday
Recess: ________________________
Alternate: _______________________
Peer to Peer Support (Program Name)
Peer‘s Playground Checklist (Elementary)
Day: ___________________
Date: _________________
(Peer to Peer Support) Name: __________________________
Did (Student with ASD name) listen to you when you were at recess?
Yes
No
Did (Student with ASD name) break any of the recess rules?
Yes
No
If yes, please write down the rule broken: ____________________
_____________________________________________________
Did you have to get the recess aide?
Yes
No
Did you try to keep (Student with ASD name) from getting into trouble
at recess?
Yes
No
Do you deserve a sticker for being a (peer to peer support) at recess?
Yes
No
Teacher or recess aides decision?
Yes
No
Please put the sheet in the yellow bin by the coat rack
(Give instructions of where sheets are stored)
Master Schedule
1st Hour
2ndHour
3rd Hour
4th Hour
LUNCH
LUNCH
LUNCH
5th Hour
6th Hour
7:45-8:35
8:40-9:30
9:35-10:25
10:30- 12:10
10:30-11:00
11:05-11:35
11:40-12:10
12:15-1:05
1:10-2:30
Max
Class
Staff
Peer
L.A. 8
Smith
Mike R.
P.Ed 8
None
Tim D.
Pre-Voc.
Russell
Courtney
Cur. Event
Russell
Dawn P.
Lunch
None
Mark E.
Math 8
Smith
Alex S.
Support
Russell
Stacy K.
Alex
Class
Staff
Peer
Math 8
Allen
Matt C.
Support
Russell
David L.
Pre-Voc
Russell
Sam L.
L.A. 8
Smith
Dave S.
Lunch
None
Kelly
Science 8
Allen
Lisa P.
History
Allen
Trent T
Science 7
None
Tracy K.
Support
Russell
Lisa J.
Math 7
Allen
Robert Q.
L.A. 7
None
Stephanie
Lunch
Smith
Steve P.
Phys. Ed.
None
Ron H.
Support
Russell
Brian H.
Math 7
None
David M.
Phys Ed 7
Smith
Ryan K.
L.A. 7
None
Ann B.
Cur. Event
Russell
Donna J.
Lunch
None
Jason F.
Community Support
Russell
Russell
Ollie O.
Lauren
Life Skills
Russell
Cathy P.
Phys Ed 6
Allen
Matt C.
Pre-Voc
Russell
Amy M.
Cur Event
Russell
Caren O.
Lunch
Allen
Paul A.
Community Support
Russell
Russell
Frank B.
Melissa
Life Skills
Russell
Norman
Science 6
None
Steve Z.
Math 6
Smith
Mike W,
Cur Event
Russell
Marcus
Lunch
Allen
Anita T.
Phys. Ed 6
None
Alan A.
Matt
Class
Staff
Peer
Ryan
Class
Staff
Peer
Robert
Class
Staff
Peer
Megan
Class
Staff
Peer
L.A.6
Smith
George K.
 Organizational System
for the Peer to Peer
Support Program
1. Check Card for Attendance
2. Get Student’s Command Central – Record Date
3. Meet your Assigned Student at their Bus
4. Take Assigned Student to their Locker
5. Check Student’s Backpack at Locker
6. Assist Student in Emptying Backpack
7. Assist Student in Taking their Supplies to their Desk
8. Assist Student in Putting Home/School Folder in Blue Bin
9. Give Money, Medications and Permission Notes to Staff
10. Ask Student if he/she needs to use the Restroom
11. Get ready for 1st Hour Class – Command Central, Book and
Supplies
12. Five minutes before the end of Class- Fill Out Student
Schedule
13. Please Put Command Central Back on Student’s Desk Before
You Leave.
1. Check Card for Attendance
2. Get Command Central and Check for the Date
3. Find Your Assigned Student
4. Assist Peer in Collecting his/her Book, Supplies and Command
Central for Class
5. If Your Peer is Absent, Check with a Staff.
6. If Your Peer has Gone to Class, Join Him/Her in the Class
7. If Your Peer is in School, but not Available at the Moment,
Check with a Staff Member.
8. Five Minutes Before the Bell, Fill out Peer’s Schedule
9. Be Sure to Put Command Central Back on Your Peers Desk
Before You Leave.
1. Check your Card for Attendance
2. Find Command Central and Check for Date
3. Find Your Assigned Student
4. Assist Peer in Collecting his/her Book, Supplies and
Command Central for Class
5. Fill Out Student’s Schedule for 7th Hour at 2:10
6. Check with a Staff Member if any Information is Missing
from 1st - 6th Hour.
7. An Assigned Peer to Peer Support Student will Pick Up the
Schedules at 2:15 for a Staff Signature and to Make Copies
8. At 2:20 Assist Your Peer in Getting Ready to Go Home
- put work material away in proper place
- organize homework to go home
- check mailboxes for notebooks and any other
information to go home
- assist students in putting notes and schedules on
their desk
- Peer should put on coat, etc. at locker and bring
backpack to desk to pack items to go home
- wait inside classroom until you are dismissed
9. Walk with Your Peer to Their Bus, Return to Room
Peer to Peer
Student Name
8/30 8/31 9/1
9/2
9/5
9/6
9/7
9/8
9/9
9/12 9/13 9/14 9/15 9/16 9/19
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3rd Hour
Matt Stone 1
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TJ Dent
Judy Smith 1
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4th Hour
Missy Fin
Jason Frac
1
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0
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1st Hour
Sam Cook
Jill Smith
Amy Cole
Mark Time
Dave Reve
2nd Hour
Tom Kitt
Kelly Mac
Pam Wang
Mike Ball
1
1
Dear Peer to Peer Support Students, Parents and Guardians,
Hello and thank you for participating in the Peer to Peer Support Program for Students
with Autism Spectrum Disorder (ASD). The staff of the Peer to Peer Support
Program will be holding a training for students who have signed up for the program.
Since this is the first year incorporating the Peer to Peer Support program into this
building, it is very important each student to attend the training.
The training is scheduled for ___________________ at ____________ Building in
Room Number # _______________. Lunch will be provided by the program.
Students or parents need to RSVP by 3pm on _____________________. To RSVP
please call one of the following phone numbers. Be sure to state your first and last
name as we will use this information for attendance and an accurate count when
ordering lunch.
P:
Or
P:
Since this training is taking place after school, all students must have their own
transportation home in order to participate. We are looking forward to meeting all the
students participating in the Peer to Peer Support Program for Students with ASD.
If you have any questions, please call the one of the numbers above and a staff
member will assist you. Also, if you have any conflicts with your class schedule
regarding the Peer to Peer Support Program, please contact your school counselor at
____________________________.
Sincerely,
Peer to Peer Support Program Staff
 Autism Spectrum Disorder includes both Autism and
Asperger Syndrome
 Autism is different than Asperger
 Autism Spectrum Disorder is sometimes called ASD
 ASD is NOT Contagious
 Most Students with ASD are Born with it
 There are more boys than girls with ASD
 Some students with ASD talk and some do not
 Most Students with ASD have Strong Interest Areas
 Most Students with ASD have a Difficult Time
Understanding Social Situations
 Students with ASD may have Unusual Preferences to Objects
or Materials
 Students with ASD Like when Things Stay the Same
 Some Students with ASD Struggle when they have to Change
from Activity to Activity
 Similarities between Both Sets of Students
 Accountability and
Promoting Student
Involvement
Peer to Peer Master Schedule for: __________________________________________
1st Hour
2ndHour
3rd Hour
4th Hour
LUNCH
LUNCH
LUNCH
5th Hour
6th Hour
7:45-8:35
8:40-9:30
9:35-10:25
10:30- 12:10
10:30-11:00
11:05-11:35
11:40-12:10
12:15-1:05
1:10-2:30
Max
Class
Staff
Peer
L.A. 8
Smith
Mike R.
P.Ed 8
None
Tim D.
Pre-Voc.
Russell
Courtney
Cur. Event
Russell
Dawn P.
Lunch
None
Mark E.
Math 8
Smith
Alex S.
Support
Russell
Stacy K.
Alex
Class
Staff
Peer
Math 8
Allen
Matt C.
Support
Russell
David L.
Pre-Voc
Russell
Sam L.
L.A. 8
Smith
Dave S.
Lunch
None
Kelly
Science 8
Allen
Lisa P.
History
Allen
Trent T
Science 7
None
Tracy K.
Support
Russell
Lisa J.
Math 7
Allen
Robert Q.
L.A. 7
None
Stephanie
Lunch
Smith
Steve P.
Phys. Ed.
None
Ron H.
Support
Russell
Brian H.
Math 7
None
David M.
Phys Ed 7
Smith
Ryan K.
L.A. 7
None
Ann B.
Cur. Event
Russell
Donna J.
Lunch
None
Jason F.
Community Support
Russell
Russell
Ollie O.
Lauren
Life Skills
Russell
Cathy P.
Phys Ed 6
Allen
Matt C.
Pre-Voc
Russell
Amy M.
Cur Event
Russell
Caren O.
Lunch
Allen
Paul A.
Community Support
Russell
Russell
Frank B.
Melissa
Life Skills
Russell
Norman
Science 6
None
Steve Z.
Math 6
Smith
Mike W,
Cur Event
Russell
Marcus
Lunch
Allen
Anita T.
Phys. Ed 6
None
Alan A.
Matt
Class
Staff
Peer
Ryan
Class
Staff
Peer
Robert
Class
Staff
Peer
Megan
Class
Staff
Peer
L.A.6
Smith
George K.
Peer to Peer Support Student Daily Schedule
Student Name: ____________________________________
Class/Activity
Homework
Tokens/Points/Cards
Date: ___________________________
Minutes in Class
Staff Comments
Peer to Peer
Comments
Homework Sheet
(ASD) Student’s name: ______________________
Class: _________
Date: __________
Hour: _____ Staff person assigned: _____________
Is a textbook required?
Yes
No
If yes, page #’s____________________________________________
Is any other book required?
Yes
No
Title of Book: _____________________________________________
Are there any other materials need to complete the homework?
_____________________________________________________________
_____________________________________________________________
Is there a handout?
Yes
If no, skip the next two ’d questions
 Is the handout attached to this sheet?
No
Yes
No
If no, where is the handout? __________________________________
_________________________________________________________
 Give a general description of the homework: ___________________
_________________________________________________________
Homework due date: ___________________________________
Upcoming Project(s):___________________________________
Due Date of Project(s):_____________
______________
Any additional information needed to be shared about the class: ___________
______________________________________________________________
Behavioral issues in this class?
Yes
No
Please give a description of the behavior: _____________________________
______________________________________________________________
(Before you move onto your next class, please make sure the homework sheet is
completed and placed on the board)
(Give directions to the peer to peer support students)
Student Information Sheet
Semester Schedule for (Student with ASD Name)
Class
Hour
Room#
Teacher
Peer to Peer
Support
1st
2nd
3rd
4th
5th
6th
Locker #__________
Combination______________
Homeroom#_______
Homeroom teacher____________
Lunch__________
Lunch Peer to Peer Support
Day of the Week
Monday
Tuesday
Wednesday
Thursday
Friday
The student I am working with is ___________________________________________
Something fun we did so far is______________________________________________
_______________________________________________________________________
_______________________________________________________________________
Do you have any questions about being a peer to peer support student?
____ YES
____ NO
If yes, what is the question: _________________________________________________
________________________________________________________________________
________________________________________________________________________
Do you have any concerns about Autism Spectrum Disorder, being a peer to peer support
student or working with your student with Autism Spectrum Disorder?
____YES
____ NO
If yes, what is the concern: _________________________________________________
_______________________________________________________________________
_______________________________________________________________________
The best part about working with _____________________________ is_____________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
Peer to Peer Support Student Signature _______________________________________
Facilitator Signature: _____________________________________________________
Permission Slips to
Participate in the
Program
 Permission Slip –
Peer to Peer Support
Program
Dear Parents and Guardians,
The peer to peer support program was created to support students with autism
spectrum disorder understand the rules and procedures of a High School/Middle
School using general education students as models. This is a new program is learning
from the research…the reach supports that students with autism spectrum disorder
benefit from peer modeling. This program has been successful throughout the state
and country.
The peer to peer support student’s role may vary from activity to activity or hour
to hour depending on the needs of the students with autism spectrum disorder. Some
of the peer to peer support students are involved in academic tasks, while others
take other roles. Prior to working with a student with ASD the peer to peer student
will participate in training on what it means to be a Peer to Peer Support student.
We encourage the parent of the peer to peer support students to attend the Open
House and Conferences so that you can better understand your son/daughters role in
the program.
The bottom portion of this paper should be completed and returned to the ______ as
soon as possible. This extends permission for your (son/daughter) to participate in
the peer to peer support program
-------------------------------------------------------------------------------------I understand that my son/daughter will be a peer to peer support student during
________hour.
___________________________
(Parent or Guardian Signature)
________________________
(Date)
Dear Parent or Guardians,
Today we spoke with your student’s class about the opportunity to become a Peer to Peer
Support Student working with students with Autism Spectrum Disorder (ASD).
The peer to peer support program is new to America Elementary. It is a support system for
students with ASD who attend the school. The program involves fourth and fifth grade
students who spend time with the students with ASD. Similar programs are established in
school districts throughout the state of Michigan and have met with great success. Not only
does the program benefit the students with ASD, but parents and teachers alike have reported
great benefits to the general education students as well. If your child decides to become a
Peer to Peer Support Student, he or she would be working with/under the supervision of the
(social worker, caseload teacher, autistic program staff, etc). As a Peer to Peer Support, your
child would help provide support and act as a participant in the activities scheduled.
As part of the Peer to Peer Support Program, your son or daughter would only miss
approximately ½ an hour of class per week, at a designated time during the school day that
has been pre-arranged with their classroom teacher.
If you would like for your child to be a Peer to Peer Support Student for students with ASD,
please fill out the information below and return this form to _____________ by
________________.
Thank you for your support with the peer to peer support program.
---------------------------------------------------------------------------------------------------
I give permission for ______________________ who is in ___________________
class to participate in the peer to peer support program at America Elementary.
Parent/Guardian Signature____________________________________________
Date _________________________________
Dear Parents or Guardians,
Your son or daughter has expressed an interest in being a peer to peer support for a
student with Autism Spectrum Disorder (ASD) during their lunch period.
There are several students with ASD in the building who would like to have friends
eat lunch with them. They would also like to have friends to play with at recess.
Your child would support the student with ASD at lunch and recess one time each
week. The primary responsibility would be as a peer role model and helper. A staff
member would be supervising at all time.
If you are in support of your child participating in the Lunch and Recess Peer to Peer
Support Program, please complete this form and have your child return it to his/her
teacher. If you have any questions, feel free to contact the __________ staff at
(xxx) xxx – xxxx.
Thank you for the support of the peer to peer support program
(Facilitator Name, Title and phone number)
-------------------------------------------------------------------------------------------My child __________________________________ who is in
__________________________’s Class has my permission to be a peer to peer
support at lunch and/or recess.
Parent Signature __________________________ Date___________
 Case Conferences
Case Conference Teacher Permission Slip
To: Teachers of the (Peer to Peer Support Student)
From: (The Student with ASD Caseload Teacher)
(Peer to Peer Support Students Name) is a (Peer to Peer Support Student) in _____ Hour.
The (Peer to Peer Support Students) serve as a role model for students with ASD.
The (Peer to peer support program) has proven extremely valuable to both the students
with ASD and the (Peer to peer support students). To ensure that each student is
appropriately informed of the effective strategies that work with the students with ASD, the
staff supporting the program schedules case conferences once a (week/month).
(Peer to Peer Support Students Name) is scheduled to attend a case conference for
(Student with ASD’s Name) on (Date
) during ______ hour. We would really appreciate
you letting (Peer to Peer Support Students Name) participate in the case conference. We
do understand that as the general education teacher you reserve the right to deny (Peer to
peer support student name) from attending the case conference.
Thank you for your support of the (Peer to peer support program) If you have any questions
don’t hesitate to call (Caseload Teacher) at ( ) xxx – xxxx.
-----------------------------------------------------------------------------------------------------------______ Can attend the case conference
______ Can not attend the case conference
_____________________________
Teacher Signature
________________
Date
Case Conference Parental Permission Slip
To: The Parents of (Peer to Peer Support Student)
From: (The Caseload Teacher of the Student with ASD)
(Peer to Peer Support Students Name) is a (Peer to Peer Support Student) in _____ Hour.
The (Peer to Peer Support Students) serve as a role model for students with ASD.
The (Peer to peer support program) has proven extremely valuable to both the students
with ASD and the (Peer to peer support students). To ensure that each student is
appropriately informed of the effective strategies that work with the students with ASD, the
staff supporting the program schedules a case conferences once a (week/month).
(Peer to Peer Support Students Name) is scheduled to attend a case conference for
(Student with ASD’s Name) on (Date
) during _________ hour. We would really
appreciate you letting (Peer to Peer Support Students Name) participate in the case
conference. We do understand that as parents/guardians, you reserve the right to deny
(Peer to peer support student name) from attending the case conference.
Thank you for your support of the (Peer to peer support program. If you have any
questions don’t hesitate to call (Caseload Teacher) at ( ) xxx – xxxx.
--------------------------------------------------------------------------------______ Can attend the case conference
______ Can not attend the case conference
_________________________
Parent’s Signature
________________
Date
Case Conference Information Sheet
You do not need to put your name on this sheet. This is an information sharing sheet used
to enhance the information presented during this case conference
Please answer the following questions as openly and honestly as possible. If you do not
have an answer or if you have an answer but it is hard to put into words just do your best.
1. The best experience with (Student with ASD) this month is when
__________________________________________________________
__________________________________________________________
2. Something I wasn’t sure how to handle this month was _______________
___________________________________________________________
3. I was frustrated by (Student with ASD) this month when he/she
___________________________________________________________
4. The biggest accomplishment that (Student with ASD) made while I was supporting
him/her was __________________________________________
___________________________________________________________
5. The biggest accomplishment that I have made being a (Peer to
Peer Support) is _____________________________________________
6. Are you interested in continuing to be a (Peer to Peer Supporter)
Yes No
If yes, which student would you like to support: ___________________
7. What three suggestions would you give to the Peer to Peer Supports
Student with ASD)
supporting (the
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
(Give the students directions about where to put the sheets when completed. Ensure
confidentiality.)
In an effort to keep the parents, staff and peers students informed of the
effective strategies that work for (Student with ASD Name) had a case
conference on (Date
)
Some positive things discussed about (Student with ASD) were:
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
Some concerns that were raised about (Student with ASD) were:
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
The action plan to resolve the concerns for (Student with ASD) is:
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
If you have any questions or concerns please contact caseload teacher
_____________________________
(Staff Person’s Signature)
______________
(Date)
 Maintenance
As staff members you are expected to fill out the Peer to Peer Support Student of the
Week Nomination Ballet.
Please fill out the form below and put in the Peer to Peer Support Student of the Week
box.
Thank you!
Date: _________________________________
Staff Name:
_____________________________________________________
I nominate (Peer to Peer Support Student’s Name) in ________ hour,
because he / she ___________________________________________
_________________________________________________________
_________________________________________________________
with (student with ASD’s name) in _________________________ Class.